be in doubt whether the cavity of the chest has been opened, it is better for him to wait and be guided by the symptoms that manifest themselves, rather than probe the wound, and run the risk of converting it into what he dreads,—a penetrating wound of the chest.” I fully agree with these judicious cautions; for there may be more danger in attempting to remove the foreign body, than in its retention, seeing the lengthened periods during which bullets may remain innocuous in the human body. Larrey mentions cases in which he has seen bullets coughed up after long retention ; and Louis (in his second memoir on ·Bronchotomy), speaks of portions of “ tents”, and even fragments of ribs, having been expectorated.

A remarkable case is reported in the Lancet of the 9th of January, 1847, by Mr. Moore of Plymouth, in which a ball had lodged near the surface of the lung for fifty years. Boyer relates a case in which the ball lodged for twenty years. There are three cases mentioned by Baron Perry (Manuel du Chirurgien d'Armée, Paris, 1772, p. 125); also two cases by Larry (Relation Chirurgicale des évènements du Juillet, 1830). In vol. xiii, page 281, of the Transactions of the Medico-Chirurgical Society, a case is related where a piece of iron hoop remained in the chest for fourteen years; also the case of Barrott, mentioned at page 59. In the following case the party showed no inconvenience from a ball apparently lodged.

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Case 29. Patrick Flanagan, aged 34, 97th regiment, wounded on the 8th of September. Ball entered at and fractured the eleventh right rib, and apparently lodged. Pulse 92; respirations 32; great nervous agitation. Ordered a large opiate.

Next morning he was calm, and made no complaint of pain or uneasiness. Pulse never rose above 80; and on the 13th of October he was sent convalescent to Castle Hospital at Balaklava.

It is stated in the Director General's Report, page 63, “ It seems very doubtful if every case in which the ball was fairly lodged within the pleural chest lining, did not die.” There are three cases alluded to of recovery under this deplorable contingency; but the Report goes on to say, they 6 may be considered open to great doubt as to whether the ball had actually penetrated”. Sharing as I do in these doubts, the cases Nos. 24, page 62, 29, just related, and 30, page 85, would nevertheless favour the possibility of recovery in cases of lodgment. It cannot be denied, however, that, cæteris paribus, it is advisable to remove the foreign substance, if it were for no other motive than the great peace of mind which this event invariably induces in the patient; and there are also cases in which the presence of the ball or foreign substance has been productive of serious mischief and danger to the wounded man. The instructive details of the following case, which occurred when I was doing duty at the Camp General Hospital, supplied to

me by Dr. Alexander Smith, staff-surgeon, 1st class, fully illustrates this point.

“ Patrick William Keane, of the 97th regiment, aged 26, was wounded on the 8th of September, at the attack on the Redan. He was in the act of loading his piece when he was struck by a bullet, which passed through the outer side of the left elbow joint, from behind forwards, injuring the head of the radius and the articulating extremity of the humerus. After passing through the joint, the bullet lodged in the left side of the chest, impacting itself between the ninth and tenth ribs. The joint was resected by the H incision, the longitudinal parts of which healed by the first intention; and, in little more than a month, the whole completely cicatrised, there never having been an untoward symptom, so far as the arm was concerned, beyond a slight threatening of sloughing, which occurred at the upper margin of the lower flap. No inconvenience was experienced from the bullet, and the wound in the side had gradually contracted into a small fistulous opening.

" At the end of six weeks, however, and when he had been up and about for several weeks, he was suddenly struck down by symptoms of acute pleurisy in the left side of the chest. There were the sharp pain and difficulty of breathing, accompanied by fever, and soon followed by dulness on percussion over the lower part of the side. There was slight displacement of the heart towards the right

side, and, at a later period, the extremities became ædematous. Soon after the commencement of the above symptoms he began, for the first time, to suffer from attacks of a convulsive cough, of so violent a character, and at times of so long duration, as to endanger life. During the paroxysms, he expectorated large quantities of frothy mucus, and on one occasion brought up about a tablespoonful of florid blood. Under the treatment usually directed against pleurisy, and the free use of anodynes, given so as to anticipate the occurrence of expected paroxysms of cough, the pain gradually abated, the difficulty of breathing and fits of coughing became less urgent, and the swelling of the hands and feet subsided; the left side of the chest at the same time became visibly flattened.”

“ Within a few days of the commencement of the pleuritic attack, the wound of the side healed and remained closed for several weeks. At the end of that time, however, it again began to discharge, and, on examination by the probe, the opening was then found to lead, not in the course of the original wound between the ninth and tenth ribs, but downwards over the tenth rib, to the space between that and the eleventh, where the bullet was detected, cut down upon, and removed. On the man's admission into hospital, the finger could detect a small flattened surface or the bullet at the bottom of the wound between the ninth and tenth ribs,

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but so deeply and firmly was it impacted, that it was deemed advisable to defer interference for its removal, until pleuritic adhesions had been set up in its vicinity. On its removal, the bullet was found to have been flattened into the shape of a wedge, having for its butt-end the smooth flattened surface felt at the bottom of the wound on admission. When it was removed, the narrow point came first, and projected between the tenth and eleventh ribs. It is therefore reasonable to infer that the wedge-shaped piece of lead entered with the pointed extremity first between the ninth and tenth ribs, eventually dropped into the chest with its point downwards, and, resting against the next lowest intercostal space,gradually advanced through it, in the usual manner, until it came within reach of the extracting forceps. After removal of the bullet, the wound rapidly healed, and the man was invalided to England in about three months from the receipt of his wounds, having regained strength, and with an arm which promised to be but little impaired in efficiency.”

That the happy medium between interference and non-interference is not always arrived at, is shown by an amusing instance related of a gallant officer who, having been subjected for a considerable period to the rather rough but wellintentioned pokings of his surgeon, calmly inquired, “What are you doing?” The reply, “searching for the ball,” was met by a gruff but pardon